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      Digital technologies and adherence in respiratory diseases: the road ahead

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          Abstract

          Outcomes for patients with chronic respiratory diseases remain poor despite the development of novel therapies. In part, this reflects the fact that adherence to therapy is low and clinicians lack accurate methods to assess this issue. Digital technologies hold promise to overcome these barriers to care. For example, algorithmic analysis of large amounts of information collected on health status and treatment use, along with other disease relevant information such as environmental data, can be used to help guide personalised interventions that may have a positive health impact, such as establishing habitual and correct inhaler use. Novel approaches to data analysis also offer the possibility of statistical algorithms that are better able to predict exacerbations, thereby creating opportunities for preventive interventions that may adapt therapy as disease activity changes. To realise these possibilities, digital approaches to disease management should be supported by strong evidence, have a solid infrastructure, be designed collaboratively as clinically effective and cost-effective systems, and reflect the needs of patients and healthcare providers. Regulatory standards for digital interventions and strategies to handle the large amounts of data generated are also needed. This review highlights the opportunities provided by digital technologies for managing patients with respiratory diseases.

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          Digital technologies hold promise to improve adherence and personalise care in patients with respiratory diseases http://ow.ly/WjTz30m71ZW

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          Most cited references71

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          Promoting professional behaviour change in healthcare: what interventions work, and why? A theory-led overview of systematic reviews

          Objectives Translating research evidence into routine clinical practice is notoriously difficult. Behavioural interventions are often used to change practice, although their success is variable and the characteristics of more successful interventions are unclear. We aimed to establish the characteristics of successful behaviour change interventions in healthcare. Design We carried out a systematic overview of systematic reviews on the effectiveness of behaviour change interventions with a theory-led analysis using the constructs of normalisation process theory (NPT). MEDLINE, CINAHL, PsychINFO and the Cochrane Library were searched electronically from inception to July 2015. Setting Primary and secondary care. Participants Participants were any patients and healthcare professionals in systematic reviews who met the inclusion criteria of having examined the effectiveness of professional interventions in improving professional practice and/or patient outcomes. Interventions Professional interventions as defined by the Cochrane Effective Practice and Organisation of Care Review Group. Primary and secondary outcome measures Success of each intervention in changing practice or patient outcomes, and their mechanisms of action. Reviews were coded as to the interventions included, how successful they had been and which NPT constructs its component interventions covered. Results Searches identified 4724 articles, 67 of which met the inclusion criteria. Interventions fell into three main categories: persuasive; educational and informational; and action and monitoring. Interventions focusing on action or education (eg, Audit and Feedback, Reminders, Educational Outreach) acted on the NPT constructs of Collective Action and Reflexive Monitoring, and reviews using them tended to report more positive outcomes. Conclusions This theory-led analysis suggests that interventions which contribute to normative restructuring of practice, modifying peer group norms and expectations (eg, educational outreach) and relational restructuring, reinforcing modified peer group norms by emphasising the expectations of an external reference group (eg, Reminders, Audit and Feedback), offer the best chances of success. Combining such interventions is most likely to change behaviour.
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            Inhaler Errors in the CRITIKAL Study: Type, Frequency, and Association with Asthma Outcomes.

            Poor inhaler technique has been linked to poor asthma outcomes. Training can reduce the number of inhaler errors, but it is unknown which errors have the greatest impact on asthma outcomes.
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              The Asthma Mobile Health Study, a large-scale clinical observational study using ResearchKit

              Use of the ResearchKit platform to track symptoms of a large cohort of asthma sufferers over time demonstrates the pros and cons of mobile health applications in large-scale observational studies.
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                Author and article information

                Journal
                Eur Respir J
                Eur. Respir. J
                ERJ
                erj
                The European Respiratory Journal
                European Respiratory Society
                0903-1936
                1399-3003
                November 2018
                22 November 2018
                : 52
                : 5
                : 1801147
                Affiliations
                [1 ]Respiratory Medicine, Royal Liverpool Hospital and Health Services Research, University of Liverpool, Liverpool, UK
                [2 ]Dept of Pediatrics, National Jewish Health, Denver, CO, USA
                [3 ]Health Services and Performance Research, Université Claude Bernard Lyon 1, Lyon, France
                [4 ]Institute of Pharmaceutical Science and Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
                [5 ]Teva Pharmaceutical Industries Ltd, Amsterdam, The Netherlands
                [6 ]RCSI Education and Research Centre, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
                Author notes
                Richard W. Costello, RCSI Medicine, RCSI Education and Research Centre, Royal College of Surgeons in Ireland, Beaumont Hospital, Beaumont, Dublin 9, Ireland. E-mail: rcostello@ 123456rcsi.ie
                Article
                ERJ-01147-2018
                10.1183/13993003.01147-2018
                6364097
                30409819
                07cbc29d-a4b7-4f6c-8b13-0398b8cc48bc
                Copyright ©ERS 2018.

                This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0.

                History
                : 18 June 2018
                : 25 September 2018
                Funding
                Funded by: Teva Pharmaceutical Industries http://doi.org/10.13039/100006259
                Categories
                Reviews

                Respiratory medicine
                Respiratory medicine

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